Notice of Privacy Practices
Effective March 2026 · Austin, TX 78734
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice takes effect March 2026 and will remain in effect until replaced.
We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. We must follow the privacy practices described in this Notice while it is in effect.
We reserve the right to change our privacy practices and the terms of this Notice at any time, as permitted by applicable law. When we make a significant change, we will post the new Notice prominently at our practice location and provide copies upon request. You may request a copy at any time by contacting us using the information listed at the end of this Notice.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
We may use and disclose your health information for different purposes, including treatment, payment, and health care operations. Some information — such as HIV-related information, genetic information, alcohol and/or substance use disorder treatment records, and mental health records — may be entitled to special confidentiality protections under applicable state or federal law. We will abide by these special protections as they pertain to applicable cases.
Treatment We may use and disclose your health information to provide, coordinate, or manage your dental care. For example, we may disclose your health information to a specialist providing treatment to you.
Payment We may use and disclose your health information to obtain reimbursement for the treatment and services you receive. Payment activities include billing, collections, claims management, and determinations of eligibility and coverage. For example, we may send claims to your dental health plan containing certain health information.
Health Care Operations We may use and disclose your health information in connection with our health care operations — including quality assessment and improvement activities, conducting training programs, and licensing activities.
Individuals Involved in Your Care or Payment We may disclose your health information to your family, friends, or any other individual identified by you when they participate in your care or in the payment for your care. If a person has legal authority to make health care decisions for you, we will treat that patient representative the same way we would treat you with respect to your health information.
Disaster Relief We may use or disclose your health information to assist in disaster relief efforts.
Required by Law We may use or disclose your health information when we are required to do so by law.
Public Health Activities We may disclose your health information for public health activities, including disclosures to:
- Prevent or control disease, injury, or disability
- Report child abuse or neglect
- Report reactions to medications or problems with products or devices
- Notify a person of a recall, repair, or replacement of products or devices
- Notify a person who may have been exposed to a disease or condition
- Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence
National Security We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may also disclose to a correctional institution or law enforcement official having lawful custody of a patient.
Secretary of HHS We will disclose your health information to the Secretary of the U.S. Department of Health and Human Services when required to investigate or determine compliance with HIPAA.
Worker’s Compensation We may disclose your PHI to the extent authorized by and necessary to comply with laws relating to worker’s compensation or other similar programs established by law.
Law Enforcement We may disclose your PHI for law enforcement purposes as permitted by HIPAA, as required by law, or in response to a subpoena or court order.
Health Oversight Activities We may disclose your PHI to an oversight agency for activities authorized by law, including audits, investigations, inspections, and credentialing necessary for licensure and government monitoring of the health care system.
Judicial and Administrative Proceedings If you are involved in a lawsuit or dispute, we may disclose your PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process — but only if efforts have been made to notify you of the request or to obtain a protective order.
Research We may disclose your PHI to researchers when their research has been approved by an institutional review board or privacy board that has reviewed the proposal and established protocols to ensure the privacy of your information.
Coroners, Medical Examiners & Funeral Directors We may release your PHI to a coroner or medical examiner — for example, to identify a deceased person or determine cause of death. We may also disclose PHI to funeral directors consistent with applicable law.
Fundraising We may contact you to provide information about our sponsored activities, including fundraising programs, as permitted by applicable law. You may opt out of receiving such communications at any time by contacting us.
Substance Use Disorder (SUD) Treatment Information If we receive or maintain any information about you from a substance use disorder treatment program covered by 42 CFR Part 2, we may use and disclose that record for treatment, payment, and health care operations only as permitted by your consent. In no event will we use or disclose your Part 2 Program record in any civil, criminal, administrative, or legislative proceedings against you, unless authorized by your consent or a court order providing you notice.
Other Uses and Disclosures of PHI Your written authorization is required — with limited exceptions — for disclosure of psychotherapy notes, use or disclosure of PHI for marketing, and for the sale of PHI. You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent we have already acted in reliance on the authorization.
YOUR HEALTH INFORMATION RIGHTS
You have important rights regarding your protected health information. Unless otherwise noted, requests should be submitted in writing to our Privacy Official using the contact information at the end of this Notice.
Access You have the right to view or obtain copies of your health information, with limited exceptions. We will provide electronic copies upon request and charge a reasonable cost-based fee for copies and postage.
Disclosure Accounting You have the right to receive an accounting of disclosures of your health information in accordance with applicable laws. If requested more than once in 12 months, a reasonable fee may apply.
Request a Restriction You may request additional restrictions on our use or disclosure of your PHI. Your written request must specify what information to limit, whether for use or disclosure or both, and to whom the limits apply.
Alternative Communication You have the right to request we communicate with you by alternative means or at alternative locations. We will accommodate all reasonable requests.
Amendment You have the right to request that we amend your health information. Your request must be in writing and explain why the information should be amended. We will notify you of our decision.
Breach Notification You will receive notifications of breaches of your unsecured protected health information as required by law.
Paper Copy You may receive a paper copy of this Notice upon request, even if you have agreed to receive it electronically.
QUESTIONS & COMPLAINTS
If you want more information about our privacy practices or have questions or concerns, please contact us. If you believe we may have violated your privacy rights, or disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict use or disclosure, you may file a complaint with us or with the U.S. Department of Health and Human Services.
We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
To file a complaint with the U.S. Department of Health & Human Services: Office for Civil Rights 200 Independence Avenue, S.W. Washington, D.C. 20201 Toll-Free: 877-696-6775 Website: hhs.gov/ocr/privacy/hipaa/complaints
PRIVACY OFFICIAL & CONTACT INFORMATION
Lake Travis Family & Cosmetic Dentistry
Privacy Official: Kirpal Toor Address: 3807 Ranch Road 620 N, Austin, TX 78734 Phone: 512-382-6985
Fax: 512-579-0016 Email: hello@laketravisdentistry.com
Notice Effective Date: March 2026